Working in Global Health: Elizabeth Barrera-Cancedda

Starting a career in global health can be intimidating. It’s a diverse field that evolves quickly and demands collaboration across disciplines, from finance to supply chain and logistics, to computer programming.

Each month we ask a seasoned colleague to share advice for those interested in forging a career in global health. This month we asked TB Analyst Elizabeth Barrera-Cancedda to discuss her path to Partners In Health.

Statements like these reaffirm my dedication to global public health, especially work aimed at strengthening entire health systems. As a public health professional, I have worked in many under-resourced and poorly functioning health systems. A few central themes emerge in all of these environments: health care delivery challenges are numerous and nebulous; the solutions seem limited and difficult to implement, and they’re often impeded by a mentality of defeat. Though lab supplies and money may indeed become “finished,” patients should never suffer from avoidable structural deficiencies in health systems.

I speak from personal experience. Ricardo Barrera Aparicio, my father, a Mexican-born United States citizen, received a cancer diagnosis too late in order to alter his reality. He hadn’t been able to access the health care system for years because he wasn’t covered by insurance. When he did seek care, he frequently could not pay for the services; the care he received was insufficient or delayed; and important information was not properly communicated. His health was neglected for many years—not because he was apathetic, but because he didn’t have adequate access to a health system.

The doctors could not tell me the etiology of my father’s cancer, though they suspected it originated in his colon. By the time he was diagnosed, he had stage IV cancer, meaning that it had metastasized to distant tissues and organs, including his lungs. I watched him decline on a pulmonary ward, waiting on biopsy results that would only be available on Monday; it was Saturday—the lab was closed on weekends. I waited for a miracle that never manifested, and I had to make a difficult decision as his only biological child: I had to take my father off life support.

After my father’s death, sitting in an empty and silent ICU unit, crying and trying to understand what just happened, I was left with this question: If he had access to simple, routine care, would his prognosis have been different?

A few months later, I had the opportunity to work with Partners In Health in Rwanda as a research project coordinator for a mental health study among families affected by HIV/AIDS. The families encountered myriad challenges when it came to seeking and accessing care. Stigma weighed heavily on children suffering from psychosis, depression, and other mental health diseases, which affected their relationships with the community, with doctors, and even with their own families. Limited financial resources and delays in seeking care caused many children to drop out of school, which only perpetuated the cycle.

Treatment options became an accessible reality rather than a luxury.

But PIH worked closely with the community and the Rwandan Ministry of Health to overcome these challenges. Partnerships with local schools and church groups allowed for new ways to educate neighbors, siblings, and community leaders about mental health. Counseling was available, support groups for the children were formed, and treatment options became an accessible reality rather than a luxury.

After leaving Rwanda and returning to Boston to work at PIH headquarters, I continued to carry those experiences from Rwanda and the experience with my father. I promised that I would challenge insufficiencies in health care systems that limit patients from obtaining superior care. As a tuberculosis (TB) analyst, I was given my first opportunity to do just that.

Presently, my chief role is to provide technical assistance to Bangladesh’s national TB Program and lead the implementation of a novel infection control strategy at the National Institute of Diseases of the Chest and Hospital (NIDCH) in Dhaka, Bangladesh. Prior to the strategy’s implementation, many cases of TB at the hospital were unidentified, which resulted in costly and delayed care. Information about TB remained siloed within different departments at NIDCH.

The infection control strategy, however, led to a significant increase in early detection and treatment rates; the quality of care for TB-affected patients greatly improved. After successfully implementing this strategy at NIDCH, other high-burden, low-resource TB countries reached out for support of their national tuberculosis programs. To date, this strategy has been successfully implemented in eight other countries—a huge step in advocating for better practices around reducing TB transmission and treating infected patients.

Working in global health means promoting a better reality for vulnerable patients who are the victims of inadequate health care delivery.

Though I am eternally grateful that my father was finally able to access a health care system, receive a diagnosis, and initiate treatment (opportunities that aren’t an option for so many people around the world), I am continually challenged by the fact that it came too late. From Atlanta to Rwanda to Bangladesh to Boston, my experiences have taught me that inefficiencies undermining health care delivery can be overcome. I hope to continue to assist Ministries of Health in developing new policies and implementing innovative approaches to health care delivery in low-income settings. Specifically, I am determined to improve aspects of health care delivery that are generally considered “non-fundable,” mundane, and of limited interest, yet that can completely alter a patient’s reality and dramatically increase positive outcomes.

Working in global health means promoting a better reality for vulnerable patients who are the victims of inadequate health care delivery. I want to help all of those daughters (and mothers, fathers, and sons) who will face very difficult decisions at times when they are most vulnerable.

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TB CARE II is funded by USAID under Cooperative Agreement Number AID-OAA-A-10-00021. The TB CARE II project team includes prime recipient, University Research Co., LLC (URC), and sub-recipient organizations Jhpiego, Partners In Health (PIH), Project HOPE along with the Canadian Lung Association (CLA); Clinical and Laboratory Standards Institute (CLSI); Dartmouth Medical School: the Section of Infectious Disease and International Health; Euro Health Group; MASS Design Group; and The New Jersey Medical School Global Tuberculosis Institute.